Integrating Mental Health Within a School-Wide System of PBIS: Systems Practices, Data

1. Integrating Mental Health Within a School-Wide System of PBIS: Systems Practices, Data Susan Barrett Implementer Partner, Center on PBISsbarrett@midatlanticpbis.org

2. Thank you ! • National TA Center on PBIS • Interconnected Systems Framework Leadership Team • Lucille Eber, Mark Weist, Kelly Perales, Katie Pohlman • California PBIS Coalition (CPC) • Handouts available pbis.org

3. MH+ PBIS= ISF Interconnected Systems Framework Where We’ve Been: • 2002-2007: Site Development with PBIS Expansion (informal and independent) • 2005: CoP focus on integration of PBIS and SMH • 2008: ISF White Paper: formal partnership between PBIS and SMH • 2009- 2013 Monthly calls with implementation sites, national presentations (from sessions to strands) • 2009-2011 Grant Submissions • June 2012- September 2013 ISF Monograph • Monograph Advisory group • 2015: ISF Learning Community, SOC Webinar Series • 2016: RCT Grant awarded • 2016: Targeted Work Group Webinars (8) • 2017: Targeted Work Group Webinars continuing, knowledge development sites across country

4. U.S. Public Health: Tiered Logic Model A few Some All Walker et al. (1996). Integrated approaches to preventing antisocial behavior patterns among school-age children and youth. JEBD, 4, 194 – 209.

5. Public Health Implementation FrameworkSocial Emotional and Behavioral Health We organize our resources Multi-Tier Mapping, Gap Analysis So kids get help early Actions based on outcomes (data!), not procedures We do stuff that’s likely to work Evidence-Based interventions We provide supports to staff to do it right Fidelity: Benchmarks of Quality And make sure they’re successful Coaching and Support Progress monitoring and performance feedback Problem-Solving process Increasing levels of intensity

6. An Interconnected Systems Framework (ISF) • A Structure and process for education and mental health systems to interact in most effective and efficient way. • guided by key stakeholders in education and mental health/community systems • who have the authority to reallocate resources, change role and function of staff, and change policy.

7. Interconnected Systems Framework Advancing Education Effectiveness: Interconnecting School Mental Health and School-Wide Positive Behavior Support Editors: Susan Barrett, Lucille Eber and Mark Weist pbis.org csmh.umaryland IDEA Partnership NASDSE

8. Enhance PBIS Tier 1Universal Precautions- “Handwashing” • Safe, positive, predictable, school environment • Care and Connections with ALL Students • Community and Neighborhood effort with students and families • Tier 1 Social Emotional Behavior Curriculum is embedded in ALL aspects of curriculum • Wellness and Employee Assistance Plans for ALL staff • Gatekeeper Training for Suicide Prevention • Increase MH literacy for ALL adults, youth within community • Universal MH Screener • Family Screener • Family Navigation System • Healthy Life Habits

9. Partnerships are needed: One in 5 youth have a MH “condition” At least 50%, perhaps 80%, of those get no treatment School is “defacto” MH provider Juvenile Justice system is next level of system default Suicide is 2nd leading cause of death among young adults Factors that impact mental health occur‘round the clock’ It is challenging for educators to address the factors beyond school It is challenging for community providers to address the factors in school

10. Current National Data: Principals’ Concerns

11. NAMI/NIMH

12. Additional Context • 33% increase in teens reporting symptoms of depression • 46% of children in the US have experienced at least one Adverse Childhood Experience (ACE) • US has highest rate of opioid use in the world • The CDC reports “electronic aggression” as an emerging public health problem • Any type of harassment or bullying that occurs through email, a chat room, instant messaging, a website or text messaging

13. Big Ideas- Change the World • How do we create platform for ALL stakeholders to demand priority for schools to be places that are: • Nurturing environments • Focus on acquiring pro-social skills • Know how to generalize across settings

14. Flipping the Script • From organizing around academics to organizing around wellness • From planning/organizing around individual needs to organizing overall environments to be nurturing • From seeking justice to increased supports within our discipline system • From specific interventions to organizing whole child reform effort using public health framework • From isolated departments and youth serving agencies to single system of delivery using public health framework • From reviewing data from a single/isolated view to 360 view • From reactive to preventative, proactive

15. WE are all “ambassadors” of Mental Health and Wellness Moving from being the only response to identified social emotional needs, to being social emotional leaders of the building. Helping to build the capacity of the rest of the staff TO

16. Tier 3 PBISSTAFF TO STUDENT RATIO Individual students that are receiving support from individualized teams of adults Tier 2 Groupings of youth that are being supported by 1-2 adults at a time Tier 1 All youth interspersed with all adults. All staff are supporting all youth. Staff Students

17. Building a Utopian Society

18. ***What if ? School Employed and Community Employed Staff use community and school data to assess the needs of young people in their school community and, together as an integrated team, select evidence based practices that match specific needs.

19. School Data  Community Data Student and System level Academic (Benchmark, GPA, Credit accrual etc) Discipline Attendance Climate/Perception Visits to Nurse, Social Worker, Counselor, etc Screening from one view Community Demographics Food Pantry Visits Poverty Rate Drug Addiction Rates Calls to crisis centers, hospital visits Screening at multiple views

20. Other DatasetsUsing Census (income, familystructure, population) Positive Assets • Parks & Playgrounds • Hospitals • Community Centers • Recreation Centers • Libraries • Religious Buildings Potential Risk Factors • Alcohol Outlets • Crime • Vacant Housing • Fast food outlets • Lottery/Gambling Outlets

21. ***What if ? We…. focused on are specific ways that everyone teaches social emotional skills across ALL settings and content areas… everyday!! …and we use our data to prioritize the skills we teach…

22. What does our curriculum look like? 1. Expectations 2. NATURAL CONTEXT (Locations) Expectations 3. Rules or Specific Behaviors

23. Specific Behaviors + Social-Emotional Skills

24. Specific Behaviors + Pro-Social Skills Specific Behaviors Pro-Social Skills Choose kindness over being right; pick up trash even if it isn’t yours Encourage others; tell peer they did a good job • Throw paper in the waste can • Use the right side of the stairway • Bring all materials to class • Keep hands, feet, and other objects to yourself

25. 1. Expectations 2. NATURAL CONTEXT (Locations) Invite those sitting alone to join in • Have a lunch plan and choose quiet or social lunch area • Invite friends to join me Expectations 3. Rules or Specific Behaviors • Use my breathing technique • Listen to my signals

27. 1. Expectations 2. NATURAL CONTEXT (Locations) STOP: Interrupt & model respect, rather than watch or join in • WALK: Invite people • who are beingdisrepected to • to join you and move away. Invite those who are alone to join in. Expectations 3. Rules or Specific Behaviors • Stop: Interrupt, • Say “that’s not ok.” • Walk: Walk away Don’t be an audience • Talk: • REPORT to an adult

28. ***Now, imagine if we… • Use that same logic at home and in our communities…

29. . PBIS Matrix for Home • I am respectfulListen to my parents • Be truthful to my parents • Play cooperatively • Speak nicely to others • I am responsible Put away my toys, bike, and equipment • Help with jobs at home • Follow my parents’ directions • Share Thursday folder with parents • I am safe Play safely with others • Stay in designated areas • Stay away from strangers • Wear bike helmet and equipment • I am prepared Finish homework and share with parent • Pack backpack at night for school the next day • Go to bed on time • Get up and get ready for school when called

33. posters

34. Sustaining PBIS Implementation Community-wide • External Coach from the community setting • Monthly Community-wide Leadership Team mtgs. • Monthly Community-wide Coaches meetings • Annual assessment of implementation • Family/Community Forum/s • On-going training (new summer staff at pool/park etc.) • Picnic and other communityevents

36. *** What if…. • We looked at attendance, tardiness, behavior referrals, suspensions, grades, visits to nurses office and loitering in hallway as an indication that our students and youth more social emotional supports? …and exclusionary responses will make it worse?

37. Broaden Use of Data: Focus on Internalizing Issues

39. ***What if… • We screened every student just like we provide vision and hearing screenings?

40. UCLA to offer free mental health screening, treatment to all incoming students • 10,000 incoming freshmen and transfer students will receive the first invitations to join the effort in the next few weeks. The voluntary screening will then be opened up to the campus community, including the health system, with the goal of incorporating 100,000 people in the research study, making it the largest and most comprehensive depression study ever undertaken. • The results will help inform research on depression and mental health and those who are found to be at risk for depression or who have depression will be offered a free, eight-week cognitive behavioral treatment program with the option of receiving additional support based on the severity of their symptoms.

41. Ask the Families!Parent Screener for ALL students transitioning to Middle school Missoula, MT Adapted from Dishion et al https://reachinstitute.asu.edu/

42. PBIS

43. ***What if… • We decreased the time between identifying a student need and providing additional supports? Label, diagnosis, insurance plan should never be a factor when someone needs help!

44. Request for Assistance Process • “I need help!” Love, me • Designated team responded within 24 hours • Student started Check in/Check Out within 72 hours

45. Using CICO as the “Organizer” • Intervention • Screening Tool • Data Collection • progress monitoring • fidelity • Teacher Support • Formal Documentation

46. “Social & Academic Instructional Groups”(sample coping skills group) Daily Progress Report (DPR) Sample NAME:______________________ DATE:__________________ Label feeling Use deep breathing Use calm words with peers Let teacher know feeling temperature if above yellow

47. When do we Kick it Up a Notch?Does everyone know that? • Student has ? consecutive minor classroom reports • Student has 2-5 ODR’s • Student has 1Suspension • Student experiences more than ? minutes out of instruction • Student misses more than ? days unexcused absences • Student- incomplete classwork/homework • Tardies • Other indicators:

48. ***What if • Our teachers had more time to foster care and connections with ALL of their students and felt more competent and confident to handle the complex needs of our young people?

49. Let’s add SNI. It will fix everything! www.safetycenter.navy.mil

50. Hexagon Tool Let’s put a “Hex” on it first!!